Practice Management Alert

Choose from 1 of 4 scenarios when deciding how to bill your physician's emergency department service

Most billers have seen this situation before: One of your physician's established patients presents to the emergency department (ED), and the attending ED doctor calls your physician to render treatment. Which codes you report for your physician's service will depend on whether the ED doctor has already provided some care or asked for your physician's opinion, and whether the patient requires admission to the hospital.

You may encounter one of four basic ED billing scenarios. Make life easy by reviewing and choosing from these options:

1. Your physician visits his patient after the ED doctor has admitted the patient. Because the patient is now an inpatient, you should report any services your physician renders with a subsequent hospital care code (99231-99233), says Keri Hegberg, CPC, owner of Gulf Coast Coding in Fort Myers, Fla.

You might be tempted to report an initial hospital care code (99221-99223) because the visit is your physician's first with the patient, but CPT states that these codes "are used to report the first hospital inpatient encounter with the patient by the admitting physician" (emphasis added). Therefore, the ED doctor could report any initial inpatient services using this code series. CPT also states that "for initial inpatient encounters by physicians other than the admitting physician," coders should choose from initial inpatient consultation codes (99251-99255) and subsequent hospital care codes. Because your physician has treated the patient before and is not simply offering consultive service, a subsequent hospital care code would be most appropriate.

2. Your physician visits his patient in the ED and decides to admit the patient. Because the attending ED doctor already performed initial treatment billable with an ED services code, you should bill the appropriate-level initial hospital care code for the hospital admission and any other services your physician renders that day. 
 
3. Your physician visits his patient and is the first provider to render treatment (the ED doctor has performed no billable services thus far). You should bill an ED services code (99281-99285) for the treatment your physician provides within the ED, Hegberg says.

4. Your physician visits his patient in the ED and renders treatment in addition to the services the attending ED doctor has already provided. If neither physician admits the patient, bill the appropriate ED services code for your physician's services, Hegberg says. Some carriers will question a non-ED physician billing an ED code, but you can do it, she adds. And carriers may raise an issue when they see two ED service codes billed on the same date of service (one by the ED doctor and one by your physician). Just make sure you have the documentation on hand to support your claim in case the carriers ask, she says.

Consultations are rare: If your physician is responding to a request for consultation by the ED doctor, which is very rare, you should report an outpatient consultation code (99241-99245) for the service. Be sure the patient's chart includes the proper documentation for a consult and that your physician has truly provided consultative services.